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Is doctors' self interest undermining the National Health Service

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39066.452847.68 (Published 01 February 2007) Cite this as: BMJ 2007;334:234
  1. Alan Maynard, professor of health economics
  1. 1York University, York, YO10 5DD
  1. akm3{at}york.ac.uk

    Recent newspaper headlines have suggested that doctors' pay is responsible for the financial crisis in the NHS. Alan Maynard argues that financial and other self interest is endangering the service, but Laurence Buckman believes the renumeration is justified

    Self interest is an integral part of every human's programming. The challenge is not to eradicate what is impossible to remove but how to channel these powerful forces to serve the individual and the public good. Economists regard self interest as the engine of economic development. As epitomised in the writing of the economics Nobel laureate Milton Friedman,1 the challenge for society is how to use self interest as an engine not only for economic development but as the means to maximise individual freedom in decentralised, competitive markets.

    For Friedman and his 18th century predecessor Adam Smith,2 the “invisible hand” of self interest and the individual pursuit of improvement in a free market with minimal government regulation would ensure that society's scarce resources were used efficiently and economic growth maximised. This, in theory, makes self interest good.

    This simplistic view ignores the realities of most markets, and the healthcare market in particular. Health care internationally …

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